tele-medicine risk adjustment
DESCRIPTION
Tele-Medicine Risk Adjustment. Agenda. What is Medicare Risk adjustment? . 1. Team Workflow. 2. ✓. 3. Summery of project specification. 4. Design. 5. Why Tele-Medicine?. 6. Web based application. 7. Conclusion. What is Medicare Risk Adjustment?. - PowerPoint PPT PresentationTRANSCRIPT
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Tele-Medicine Risk Adjustment
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Agenda
What is Medicare Risk adjustment?
Conclusion
Summery of project specification
Why Tele-Medicine?
Team Workflow
Design
Web based application
✓
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• Implemented in 2003 - (MMA)• Became fully in effect in 2007
• Medicare risk adjustment model • Method which collects data from a large pool of
beneficiaries to estimate predicted costs on average for each of the component factors: age, sex, county of enrollee, known as demographics
What is Medicare Risk Adjustment?
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• In the MRA model, each member has been assigned a risk score
• Member Risk scores are based on diagnoses submitted by physicians, hospital inpatient and outpatient facilities
• Member Risk scores are calculated based on diagnoses from the prior year Dates of Service
• MRA model groups the ICD-9 codes (encounter data) into HCCs (Hierarchical Condition Categories) that contribute to the member risk score
What is Medicare Risk Adjustment?
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Team Workflow
1Dr. Jean Coppola – Pace University
Client
Ray – Community Urgent Care Holdings
Client
3Dr. Amar Gupta – Pace University
Client
Our team consists of 4 people with different skills:• Research• Programming• Web design• Testing
• We have weekly meetings every Thursday at 9 pm to discuss our work and the next steps
• 6 meetings with our clients till now
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– Browser based questionnaire to capture some high level data that would be sued by the managed care plans to identify at risk patients that may not be managing underlying conditions
– This could be done off a tablet - and then buckets that the managed care plans would have access to as they relate to their members
What do our clients want?
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• Use friendly web based application:– Create Browser Base Additional Intake
Information Form • patients name, date of birth, gender, age, weight, height,
contact information, insurance plan with member id, primary care physician, last visits, underlying conditions, medications, blood pressure, and glucose
– HIPAA Compliant Database– Collect Data to identify ‘at risk’ patients for
not managing underlying conditions– Data will be generated into downloadable
reports
Project Specifications
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Design
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Design
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Log in First (as Member or Insurance Company)Start a New RecordReview Your RecordFind a Physician (Online Session)
Personal Info: Name, DoB, Weight, Height, Phone #, SSN, Last Visit, Insurance Company, Policy Number, Underlying Conditions, Family History, Current Medical Conditions, Medication
Design
Data Storage
Start New
Main Page
EncryptedSorted by SSNHIPPA Compliant
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Why Tele-Medicine?
• The use of telemedicine reduces travel and many other stresses for the patient
• It has allowed health facilities to expand their reach beyond their offices
• It allows hospitals to create networks to provide each other with support – By easily sharing their expertise outside their own institutions,
doctors can offer incredible value to their medical colleagues and those colleagues’ patients
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Users
The users of the program will be able to log into their own accounts and have the option to select a variety of different conditions that patients could have
Insurance Companies
Health Care Professionals
Doctors
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Testing Strategy
Collect data
Process data Outcome
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THANK YOU!